Four years after Hurricane Katrina devastated New Orleans, the slow recovery pace continues to disrupt lives and contribute to personal stress. Childbearing women and families with small children remain among the most vulnerable to mental and physical health disruption as they face reduced access to health care, neighborhood instability, lack of social support systems and a level of poverty that mirrors that present before Katrina. No previous studies have been conducted on the long term impact of disaster recovery on childbearing women, either as disaster survivors or new residents who move into the disrupted community. Data are needed to determine how differing models of prenatal care employed by women in conjunction with self-selected care activities, such as complementary and alternative medicine, serve to buffer the effects of disaster recovery. Six hundred prenatal women (24-41 weeks gestation) will be recruited, representing three types of community prenatal care: a) Centering Pregnancy(R) prenatal care, b) traditional prenatal care, without participation in the Healthy Start Program, and c) traditional prenatal care, with participation in the Healthy Start Program. Women will be surveyed once during the pregnancy for information on demographics, depression, perceived stress, social support, health, neighborhood stressors, access to care, type of prenatal care, and satisfaction of care, to understand how childbearing women are coping with recovery stressors and to plan future interventions to minimize perinatal risks. Physical health indicators, such as complications of pregnancy, smoking, drug abuse and perinatal outcomes (including gestational age and birth weights) will also be determined. The specific aims of this study are to: (1) examine the stress reduction and coping strategies women use prenatally;(2) examine the relationship between different models of prenatal care and psychosocial and physical outcomes, including depression, pregnancy-specific anxiety, perceived stress, and health behaviors;and (3) examine the interaction of stressful disaster recovery experience (e.g., threats and losses, daily hassles, rebuilding, recovery, crime, and safety concerns) and social support with the three different models of prenatal care in determining depression, stress levels and physical health indicators. The overall goal of this study is to describe stressors, the protective mechanisms used, and the potential sources of resilience for prenatal women who are currently living in a long-term, post-disaster environment. PUBLIC HEALTH RELEVANCE: This work will fulfill public health goals of a) assessing the effects of different models of prenatal care on women's mental health and health behaviors, b) helping plan interventions for women living through disaster recovery and better understand the long-term effects of disaster recovery on childbearing women, and c) providing information relevant to interventions for women living in chronically stressful post-recovery environments.